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Texila International Journal of Public Health
Volume 7, Issue 2, Jun 2019
Plasmodium Falciparum Screening among Individuals Purchasing Antimalarial Drugs for Self-Medication
Article by Oche Joseph Otorkpa Public Health Texila American University Georgetown, Guyana
E-mail: [email protected]
Abstract
The objective of this study was to ascertain the pattern and reliability of self-diagnosis and self-
medication with antimalarial drugs. The sample size was 470 comprising 264 men and 206 women. There
is a significant difference between the screening results for men and for women (P=0.01186). 71.49% of
participants purchasing antimalarial drugs for self-medication in the study area had no parasite antigen
in their blood stream. Self-medication practices with antimalarial drugs was found to be more prevalent in
the age group 31-40, which accounted for 171 (36.36 %) of participants. Individuals >60 years of age were
the least involved in the practice of self-medication practice with antimalarial drugs. Age was found to be
significantly associated with self-medication practices with antimalarial drugs (P=0.028156). More single
individuals were engaged in the practice of self-medication with anti-malarial drugs 235(50%) as
compared to married participants 206(43.83%). The results show that individuals with formal education
were the most engaged in self -medication practices with anti-malarial drug as tertiary educated
participants accounted for 257(54.68%) as compared with individuals with no formal education (53 or
11.28%). The level of accuracy of self–diagnosis for malaria was higher in women 30.58% as compared to
men (21.97%). The precision of self-diagnosis was also highest among participants aged > 60(41.82%)
while the lowest was level of accuracy was recorded among participants aged 18-30(15.14%). Based on
the level of education, the accuracy of malaria diagnosis was higher in tertiary educated participants
(29.18%) and lowest among participants with no formal education (15.09%).
Keywords: Antimalaria, Self-Medication, Malaria, Prevalence, Self-Diagnosis.
Introduction
Plasmodium falciparum is one of the six protozoan parasite, belonging to the species Plasmodium which
causes malaria in humans. This parasite is transmitted to humans through the bites of infected female
Anopheles mosquitoes. The organism is responsible for a vast majority of the mortality and morbidity
associated with malaria infection, it accounts for about 80% of malaria infections in sub-Saharan Africa
and almost every death due to malaria is caused by the same organism (World Health Organization, 2008).
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DOI: 10.21522/TIJPH.2013.07.02.Art018
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Figure 1. Photo credit: http://www.parasitesinhumans.org
Self-medication refers to the use, administration or consumption of medicinal substances in an attempt
to treat certain self-recognized disorders, conditions or symptoms, this also includes the practice of using
over-the-counter drugs and or prescription drugs which have not been prescribed by a medical practitioner
on self in order to treat or alleviate certain conditions.
Rapid Diagnostic Tests (RDT) are immunochromatographic tests that detect specific parasite antigens
in blood. The Malaria antigen detection tests are conducted using the (RDT). The kits assay and detect
malaria antigen in the blood sample and are intended to allow simple, swift, and precise diagnosis of malaria
in areas where standard laboratory diagnosis is not available. In standard conditions these devices offer
high sensitivity, specificity, rapidity, ease of performance and interpretation. The ability of the kit to
differentiate species, allows for quantitative analysis. The endemic nature of malaria in Nigeria, has made
the rapid, and reliable diagnosis of the fundamentals effective to the management and control of the disease,
the introduction of malaria rapid diagnostic devices opened a new era of diagnosis that was expected to
challenge the existent limitations of other diagnostic tests.
Background of study
Despite the discovery of Artemisinin Combination Therapy (ACTs) which is currently the drug of choice
in the treatments and management of P. falciparum infection, the condition remains one of the most
devastating infectious diseases in the world and Africa’s greatest public health challenge, because despite
many successes recorded with the advent of this new therapy, the emerging trend of resistance continues to
pose a serious cause for concern. Self-medication on the other hand is gradually becoming a way of life in
virtually every community in Nigeria, largely due to long waiting time in government owned health centers
and the exorbitant charges and fees at private health facilities. What is not known however are the accuracy
of these self-diagnosing practices and the prevalence rate of Plasmodium falciparum among those
purchasing antimalarial drugs to treat incidence of malaria.
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Statement of the problem
The importance of proper diagnosis of disease conditions especially malaria in communities across
Nigeria has been relegated to the background, with widespread use and indiscriminate administration of
antimalarial drugs including injectable antimalarial agents without diagnosis of real or perceived conditions.
Basic research questions
This study was expected to answer the following basic research questions:
1. What percentage of individuals purchasing antimalarial drugs for self-medication are actually infected
with Plasmodium falciparum.
2. What percentage of individuals purchasing antimalarial for self-medication are free from the parasite.
3. What are the demographical distribution of those engaged in the practice of self-medication.
Objectives of the research
The objective of this study is to ascertain the reliability of self-diagnosis and medication in malaria
management and medication practices by screening individuals purchasing antimalarial drugs for self-
medication with a view to determining the level of reliability of such practices, the demographical pattern/
structure of the individuals who are engaged in the practice, which will in the end provide valuable
information for key stakeholders, the Community and government and assist in enlightenment programmes
, policy change advocacy and programs/ clinical projects geared towards stemming the tide of relapse and
the rising incidence of drug resistance in the management of malaria.
Significance of the study
This study is hugely significant because of the burden malaria places on communities’ families and
individuals especially in developing countries where treatment of the disease account for a significant
percentage of the health budgets of the population. Determining the appropriateness or otherwise of these
practices could prevent loss of lives, provide important information on the practices and present a clear
picture of the situation to policy makers, advocacy groups and public health practitioners.
Hypothesis
Null hypothesis H0
Most individuals purchasing antimalarial for self-medication do not have P. falciparum parasite in their
blood stream.
Alternative hypothesis H1
Most individuals purchasing antimalarial for self- medication have P. falciparum parasite in their blood
stream.
Limitation of study
This research was carried out specifically in community pharmacy outlets and drugs stores in Kogi state
and cannot the directly extrapolated.
Review of literature
Although malaria is preventable it has remained one of the biggest medical burden in developing
countries especially in sub-Saharan Africa where thirty countries account for 90% of global malaria death.
Uganda, Ethiopia, Democratic Republic of Congo (DRC), and Nigeria account for nearly 50% of global
malaria deaths, Despite the high prevalence rate of the disease, the condition is often misdiagnosed because
its symptoms such as fever, nausea and fatigue sometimes mimic the symptoms of other infectious diseases,
such as influenza and typhoid fever, this misdiagnosis often leads to the administration or consumption of
unnecessary medication which raises the cost of healthcare and increases the likelihood of the development
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of parasite drug-resistance. In sub Saharan Africa were an estimated 80 to 90% of all malaria deaths occur,
It is estimated that malaria costs Africa US$12 billion per year in direct costs and reduces GDP growth by
1.3 percent annually, The burden is carried mostly by poor and vulnerable families whose access to current
prevention and treatment options are limited (Rowe et al.,2006).
Self-medication is becoming an increasingly important area within the healthcare. Because it moves
patients towards greater independence in making decisions about management of minor illnesses and
diseases thereby promoting empowerment. Self-medication also has advantages for healthcare systems as
it facilitates better use of clinical skills, provides increased access to medication and may contribute to
reducing prescribed drug costs associated with private health care providers and publicly funded health
programmes (Omolase et al.,2007). However, self-medication is associated with risks such as misdiagnosis,
use of excessive drug dosage, prolonged duration of use, drug interactions and polypharmacy. The latter
may be particularly problematic in the elderly (Hughes et al., 2001). A research conducted by Montastruc
et al on the Pharmacovigilance of self-medication reported that, the side effects of self-medication are
relatively frequent and can be serious. It also showed that these side effects occurred more often in women
than in men (Montastruc et al., 1996).
A study which investigated Self-medication and non-doctor prescribing of drugs in Pokhara Valley,
Western Nepal described self-medication as a common practice in developing countries. The study reported
that, the common reasons given for self-medication were mild illness, previous experience of treating a
similar illness, and non-availability of health personnel. 70% of respondents sampled in the study were
prescribed allopathic drugs by a non-allopathic doctor. The compounder and health assistant were common
sources of medicines. Paracetamol and antimicrobials were the drugs most commonly prescribed. A
significantly higher proportion of young (<40 years) male respondents had used self-medication than other
groups in the study population (Shankar et al.,2002). Similarly, a study published in the Ethiopian journal
of health and development which reviewed Self-medication practices in three towns of North West
Ethiopia, agreed with the submission that most illnesses in developing countries do not come to the attention
of physicians; as many of these are either tolerated or self-medicated. The retrospective study assessed the
magnitude, type and factors of self-medication in three towns of Northwest Ethiopia using a community-
based cross-sectional survey with two-week illness recall with the aid of an open-ended questionnaire
consisting of general demographic and socioeconomic questions as well as questions on illness in the last
two weeks prior to the interview and treatment strategies. The results showed that, of a total of 1880
households evaluated 1190 (11.6%) individuals in 984 households reported at least one episode of an illness
and of whom 324 (27.5%) conducted self-medication. Self-medication was conducted using both modern
pharmaceuticals and traditional medicines. Financial reasons and the triviality of illnesses were also the
top-two reported factors of self-medication (Abula & Worku 2017).There appears to be also widespread
self-medication practices among health care personnel, a study on self-medication among health workers
in tertiary institutions conducted in South-West Nigeria reported that, the prevalence of self-medication is
relatively high and inappropriate self-medication results in wastage of resources, resistance to pathogen and
generally entails serious health hazards (Babatunde et al., 2016).
In recent years, there appears to be an emerging trend which shows that there is an increasing impulse
for individuals to self-administer anti-malarial drugs whenever they feel unwell, a recent study conducted
in Nigeria reported that (85%) of respondents admitted to self-medication. According to the research, drugs
utilized could be single, usually analgesics (26.5%) and anti-malaria (15.9%) or in combinations, usually
antimalarial-analgesics (22.4%), antimalarial analgesic-antibiotic (15.3%) and antibiotic-analgesic
(10.0%). The major reason cited for self-medication by the respondents in the study were their perception
(Babatunde et al., 2016). Another study which evaluated the prevalence of self-medication with antibiotics
and antimalarials in Khartoum State, Sudan as well as the factors linked with self-medication sampled 600
households (1750 adult persons), using a stratified clustered sampling technique, results from the study
shows that 1,293 adults which represents (73.9%) of the study population had used antimalarial or antibiotic
without a prescription within one month prior to the study. Eight hundred and forty-one (48.1%) of the
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respondents agreed that they have used antibiotics, 43.4% used antimalarial, while 17.5% used both. The
main reason that was indicated for the self-medication in this study was financial constraints. The main
source of medicines was the private pharmacies, which were regarded as a cheaper alternative to other
primary healthcare sources (Awad et al., 2017).
Presumptive treatment can increase 'drug-induced disease', death and inflect a negative impact on
individual and family finances. This growing trend, have been attributed to the wide spread availability of
over-the counter (OTC) drugs, urge of self-care, extensive advertisement of drugs, lack of functional health
care services, poverty, ignorance, availability of drugs in places other than drug shops , high fees at health
facilities and inadequate family support , a study which evaluated the risk of self-medication practices listed,
incorrect self-diagnosis of conditions, delays in seeking medical advice when needed, dangerous drug
interactions, incorrect manner of administration, infrequent but severe adverse reactions, incorrect choice
of therapy, incorrect dosage, masking of a severe disease and risk of dependence and abuse as many of the
risks involved in self-medication (Ruiz, 2010). However, there is scarcity of data and information on
misdiagnosed Plasmodium falciparum cases among self-medication and presumptive treatment
practitioners. Furthermore, the advent of rapid diagnosis provided a platform to evaluate the claim and
perceptions espoused by adherents of self-medication (Murray et al, 2003).
A review of malaria diagnostic tools: microscopy and rapid diagnostic test (RDT) published in The
American journal of tropical medicine and hygiene, stated that Giemsa microscopy and rapid diagnostic
tests (RDTs) represent the two diagnostics most likely to have the largest impact on malaria control today.
These two methods, each with characteristic strengths and limitations, together represent the best hope for
accurate diagnosis as a key component of successful malaria control (Wongsrichanalai et al.,2007). Despite
this advance, self-medication has been on the rise without recourse to any diagnostic tool. A study
conducted in Enugu State, southeast Nigeria reported that self-medication was responsible for the highest
percentage of drug prescriptions (46.1%), while prescriptions from health centers accounted for 18.2%. The
study also observed that although Nigeria’s malaria treatment policy recommends a regular monitoring of
drug utilization in order to generate critical information on the effective use of anti-malarial drugs the
information at the retail end which constitute a major part of its drug distribution and consumption network
is currently limited. The study further observed a significant level of inappropriate use of drug at the retail
end (Ezenduka et al., 2014).
On the other hand, another study which evaluated the economic burden of malaria in Nigeria using the
willingness to pay approach in 2007 indicated that households were prepared to pay an average of about
1,112 Nigerian Naira (USD 9.3) per month for malaria treatment this figure is about Naira 427 (USD 3.6)
in excess of their current average expenditure on malaria on a monthly basis. Another important finding
from this study was the willingness of households to pay an average sum of 7,324 Nigerian Naira (USD
61) per month for the control of malaria. Again, this figure represents an excess of about 2,715 Nigerian
naira (USD 22.6) over their current cost of managing the disease (protection, treatment and indirect costs),
bringing the individual into perspective this figure represents 611.7 Nigerian Naira (USD 5.1) per head per
month and 7,340 Nigerian Naira (USD 61.2) each year, for a country with a population of about 120 million
this figure translates to Naira 880,801 million per annum representing about 12.0 per cent of Gross
Domestic Product (GDP) (Jimoh et al.,2007) using the country’s last recorded Gross domestic product of
481.1 billion USD (2015) (Trading economics, 2017) ,this translates into a whopping 57.72 Billion USD
dollars per annum , as such any action that will help alleviate economic burden of malaria in Nigeria is
likely to have a significant impact of the socio economic wellbeing of the country’s citizens hence the need
for a study to unearth critical data that will provide valuable information for critical stakeholders and policy
makers in the country that will enable them take decisions that will reduce the burden on communities and
enhance the living standards of the people
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Methodology
Design and duration of study
A cross-sectional study was conducted between July- October 2017 at the peak of the rainy season when
the incidence of malaria is at its highest due to increase in the number of mosquito breeding sites as a result
of widespread pools of stagnant or slow flowing water bodies during the period.
Study area
This study was conducted in Lokoja, Lokoja is located in North central Nigeria, and it lies at the
confluence of the Niger and Benue rivers on 7.80 latitude and longitude 6.74 at an elevation of 53 meters
above sea level. The city has a population of 195,261 as at the 2006 census.
Built-up area, sand bars and vacant land occupy least land cover (28.31%) while urban agricultural land,
vegetation and water bodies covered 344.33km2 (59.72%), 41.98km2 (7.28%) and 18.51km2 (3.21%),
respectively. The land surface temperature (LST) value ranges from 0.92 to 0.989 with an average of 0.955
whereas the highest emissivity is recorded where vegetation is very dense and the lowest recorded for Sand
bars. The LST for sand bars, vacant land and built-up area has the highest average temperatures of 41.13°C,
35.66°C and 34.56°C, respectively (Ifatimehin & Ujoh, 2014).
Target study population
Adults Purchasing Antimalarial drugs for self-administration/ medication in Community Pharmacies in
Lokoja Metropolis
Sampling technique
Blood samples for analysis was collected by from volunteers by employing the convenience sampling
approach. This non-probability sampling method relies on data collection from members of the population
who were conveniently accessible or available to take part in the study.
Inclusion criteria
All customers, clients and patients purchasing antimalarials at community pharmacies for self-
medication aged 18 years and above who consented to participate in the study were included.
Exclusion criteria
All customers, clients and patients who were not purchasing antimalarials at community pharmacies for
self-medication were excluded from the study, also excluded were the very ill, and those below age of 18
and customers who declined consent.
Sample size
The desired sample size was determined using the Fishers formula of sample determination (Ngwenyi,
2012), using the prevalence rate of malaria in Kogi state Nigeria at 54.75 (Ifatimehin, Falola, & Odogbo,
2014). The sample size to studied during this research will be;
Z2 p X q
N= d2
N = the sample size (assuming the population n is greater than 10,000)
z = the standard normal deviation, set at 1.96, which corresponds to 95% confidence level
p = Prevalence of the disease in the area 54.75
q = 1.0 – p
d = the degree of accuracy desired, here set at 0.05 corresponding to the 1.96.
Sample size N= 1.962 x 0.547 x (1 - 0.5) =
0.052
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3.8416X0.2735 =420
0.0025
Because attrition can occur when participants have missing data at one or more point (Dumville,
Torgerson, & Hewitt,2006), 10 percent attrition rate was included and 42 was added and the entire sample
size was rounded up to 470. Four hundred and seventy participants (470) was the study population for this
research
Ethical considerations
Ethical approval was obtained from the Ministry of Health Headquarters Lokoja body (Appendix 2) the
body charged with the responsibility for compliance with ethical standards in the state. The following
ethical considerations were performed during this research
1. The aim and objectives of the study was clearly outlined for all respondents in the language and manner
they understand.
2. The respondents were informed of the possible implication in terms of pain, time and resource they
might incur during the test
3. All participants were informed about their right to participate or to decline from participating in the
study.
4. An informed consent was obtained from all participants.
Instrument of data collection
Blood samples collected from the study participants was tested for Plasmodium falciparum parasites
using a rapid diagnostic (RDT} kit that detects specific parasite antigens in blood.
Specificity and sensitivity of instrument
Research has shown that the Rapid Diagnostic Test kit (RDT) to be a very reliable tool for diagnosis of
malaria. A study to assess the reliability of the RDT for Malaria diagnosis conducted in the forested belt of
central India showed that For P. falciparum, the sensitivity and specificity of the test were 96% and 95%
respectively, with a positive predictive value (PPV) of 85% and a negative predictive value (NPV) of 99%
and concluded that the RDTs were reliable for malaria diagnosis ( Bharti, 2008)
Procedure for sample collection
The process was carried out according to the standard operating procedure described by (UNITAID,
2017), the procedure involves 7 steps
1. Explaining to the patient what the test is for and procedure before proceeding to open the package
tearing containing the test cassette, buffer and dropper.
2. The next step involved putting on protective covering and a pair of new gloves before proceeding to
disinfect the finger with alcohol swab and the puncture site by pricking at the tip of the 4th finger of
the non - dominant hand using a lancet.
3. By gently applying pressure to the finger the first drop of blood emerged which was wiped out using a
dry piece of cotton wool leaving no cotton strand, tissue fluids or other contaminants that may affect
the results.
4. Applying gentle pressure on the finger a second time led to the expression of a new blood drop which
was collected using the blood collection device (pipette, dropper or capillary tube) provided in the RDT
kit, to collect the required volume of blood (5 μl) in accordance to manufacturer ‘s instructions
5. After the sample collection the blood was transferred into the appropriate compartment of the on the
RDT cassette as stipulated by the manufacturer after which the exact amount of buffer drops as
stipulated by the manufacturer (two drops) at the appropriate portion of the test device was added.
6. The test was timed as recommended by the manufacturer( 15minutes) before the reading were taken
by viewing the result window of the cassette for color band(s) appearance indicating either Negative
was recorded for the presence of only a control band and positive result was recorded for P. falciparum
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by the appearance of both the test color band and the control band. an Invalid result was recorded when
test band and the control does not appear or the test band appears and the control band does not, the
results were recorded in the data entry sheet. (appendix 1)
Figure 2. Photo credit: World Health Organization (WHO)
Figure 3. An RDT kit showing negative result for Plasmodium falciparum
Figure 4. An RDT kit showing positive result for Plasmodium falciparum
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Results and data analysis
Socio- demographic characteristics
Table 1 a
Sex Number Percentage
Male 264 56.17%
Female 206 43.83%
Total 470 100%
Table 1 b
Age
(years)
Number Percentage
18-30 86 18.30%
31-40 171 36.38%
41-50 83 17.66%
51-60 75 15.96%
>60 55 11.70%
Total 420 100%
Table 1 c
Religion Number Percentage
Christianity 238 50.64%
Islam 225 47.87%
Others 7 1.49%
Total 470 100%
Table 1 d
Marital
Status
Number Percentage
Single 235 50.00%
Married 206 43.83%
Separated 29 6.17%
Total 470 100%
Table 1 e
Education Number Percentage
Primary 58 12.34%
Secondary 102 21.70%
Tertiary 257 54.68%
None 53 11.28%
Total 470 470
Shows the frequency distribution of the participants based on demographic characteristics. The study
population comprises of 264 men representing 56.17 percent and 206 women representing 43.83 % of these
figures those in the age bracket 18-30 were 86 (18.30%), 31-40 were 171(36.38%), 41-50 were 83(17.66%),
51-60 were 75(15.96%) and those whose age was greater than 60 were 55(11.70%). The religious
distribution showed that there were 238 Christians representing 50.64 % Muslims 225 representing 47.87%
and other religious adherents were 7 or 1.47%. Based on educational qualification there were 58 (12.34%)
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participants who had primary education, 102 (21.70%) were educated up to secondary level, 257
participants or 54.68% of the population had tertiary level of education while 53 or 11.28% of the study
population had no formal education.
Table 2 a. Plasmodium falciparum screening results based on sex of the participants
Sex Negative Positive Invalid Total
Male 202(76.52%) 58(21.97%) 4(1.51%) 264 (100%)
Female 134(65.05%) 63(30.58%) 9(4.37%) 206 (100%)
Total 336 121 13 470(100%)
The chi-square statistic is 8.8692. The p-value is 0.01186. The result shows that there is a significant
difference between the Plasmodium falciparum screening results for men and for women.
Table 2 b. Plasmodium falciparum screening results based on age (years) of the participants
Age (years) Negative Positive Invalid Total
18-30 70(81.40% 13(15.14%) 3(3.49%) 86(100%)
31-40 116(67.84%) 49(28.65%) 6(3.51%) 171(100%)
41-50 66(79.52%) 15(18.07%) 2(2.41%) 83(100%)
51-60 53(70.67%) 21(28.00%) 1(1.33%) 75(100%)
>60 31(56.36%) 23(41.82%) 1(1.82%) 55(100%)
Total 336 121 13 470 (100%)
The chi-square statistic is 17.1935. The p-value is 0.028156. The result shows that there is a significant
association between the Plasmodium falciparum screening results for the different age groups
Table 2 c. Plasmodium falciparum screening results based on religion of the participants
Religion Negative Positive Invalid Total
Christianity 169(71.01%) 62(26.05%) 7(2.94%) 238(100%)
Islam 162(72.00%) 58(25.78%) 5(2.22%) 225(100%)
Others 5(71.44%) 1(14.28%) 1(14.28%) 7(100%)
Total 336 121 13 470(100%)
The chi-square statistic is 4.007. The p-value is 0.405053. The result shows that there is a no significant
difference between the Plasmodium falciparum screening results between Muslims Christians and other
religions.
Table 2 d. Plasmodium falciparum screening results based on the marital status of the individuals
Marital
Status
Negative Positive Invalid Total
Single 170(72.34%) 57(24.26%) 8(3.400%) 235(100%)
Married 146(70.78%) 55(26.70%) 5(2.43%) 206(100%)
Separated 20(68.97%) 9(31.03%) 0(0.00%) 29(100%)
Total 336 121 13 470 (100%)
The chi-square statistic is 1.885. The p-value is 0.7569 The result shows that there is a no significant
difference between the Plasmodium falciparum screening results for participants based on their marital
status.
Table 2 e. Plasmodium falciparum screening results based on the educational level of the participants.
Education Negative Positive Invalid Total
Primary 41(70.69%) 15(25.86%) 2(3.45%) 58(100%)
Secondary 76(74.51%) 23(22.55%) 3(2.94%) 102(100%)
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Tertiary 175(68.10%) 75(29.18%) 7(2.94%) 257100%)
None 44(83.02%) 8(15.09%) 1(1.89%) 53(100%)
Total 336 121 13 470(100%)
The chi-square statistic is 5.7143. The p-value is .455944. The result shows that there is a no significant
difference between the Plasmodium falciparum screening results for participants based on their educational
qualifications.
Table 3a. Frequency distribution of Plasmodium falciparum screening results for the whole study population
Result Number Percentage
Negative 336 71.49%
Positive 121 25.74%
Invalid 13 2.77%
Total 470 100%
Overall 336 participants representing 71.49% tested negative to Plasmodium falciparum antigen, 121
participants or 25.74% tested positive while 13 test results were invalid.
Observations and findings
One the major findings from this research is the pattern of frequency distribution of Plasmodium
falciparum screening results which showed that most of the participants 336 representing 71.49%
Purchasing Antimalarial Drugs for Self-Medication in the study area had no Plasmodium falciparum
antigen within their blood stream. This is almost three times the number of individuals who actually tested
positive for Plasmodium falciparum which were 121 or 25.74%. Self-medication practices with antimalarial
drugs was also found to be more prevalent in the age group 31-40, they accounted for 171 or 36.36 % of
the individuals purchasing drugs for antimalarials. This was closely followed the age group 18- 30 which
recorded 86 individuals. Individuals >60 years of age were the least involved in the practice of self-
medication practice with antimalarial drugs.
Another important observation that was noted from this research was that, men and women, Christians
and Muslims are almost equally engaged in the practice of self-medication with no much difference in the
frequency of their engagement in the practice with anti-malaria drugs within the location of study. This
research also noted that more single individuals were engaged in the practice of self-medication with anti-
malaria drugs 235(50%) as compared to married participants 206(43.83%) and participants who were
separated from their spouses (divorced, widowed, widower, separated) which were 29 or 6.17% of the study
population. Another key finding from this study with ramifications for health promotion activities is the
observation on self-medication practices based on educational qualifications. The results show that
individuals with formal education were the most engaged in self -medication practices with anti-malaria
drugs, tertiary educated participants accounted for 257 or 54.68%, secondary level educated participants
21.7% and participants educated up to primary school level were 58 or 12.34%. Individuals with no formal
education were 53 representing 11.28 percent of the entire study population.
The level of accuracy of self–diagnosis for malaria was higher in women 30.58% as compared to men
who recorded 21.97%. The precision of self-diagnosis was also highest among participants aged > 60 who
recorded 41.82% and while the lowest was level of precision or accuracy was recorded among participants
aged 18-30(15.14%). Based on the level of education the accuracy of malaria diagnosis was higher in
tertiary educated participants 29.18% and lowest among participants with no formal education 15.09%.
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Discussion
In the entire study population, male made up a larger percentage with 56.17% as compared to women
who account for 43.83 %. This is similar to a prevalence study on malaria parasites in adults and its
determinants in malaria endemic area conducted in the Kisumu County, Kenya which reported that, men
were 514 or 53.21% as compared to women who were 452 or 46.795 (Jenkins et al.,2015), and another
study conducted by (Erhun , Agbani, , & Adesanya, 2005) on Malaria prevention: knowledge, attitude and
practice conducted in Southwestern Nigerian communities which involved a study population of 231
participants was made up 146 men representing 63.20% and 85 women or 36.80%. This is in contrast with
another study conducted in Gboko, Benue state, North central Nigeria, which evaluated malarial infection
among patients attending a semi-urban based hospital and performance of HRP-2 pf Rapid diagnostic Test
(RDT) in screening clinical cases of Plasmodium falciparum malaria reported. The study involved 258
participants comprising 158 women (61.24%) and 100 men (38.76%) (Houmsou et al., 2011). this variation
may be largely due to the fixed hospital location in which the study was conducted. There was a statistical
significance in the distribution (p=0 .01186) indicating that sex significantly associated Plasmodium
falciparum screening results.
Self-medication practices with antimalarial drugs was also found to be more prevalent in the age group
31-40, they accounted for 171 or 36.36 % they also recorded the highest number of positive Plasmodium
falciparum screening results. This agrees with the findings of a Plasmodium falciparum prevalence study
in Amerindians inhabiting the Venezuelan amazon. The study conducted by Sanchez et al reported that
96.9% of the adults aged 31-40 years exhibited high ELISA values to P. falciparum (Sanchez, Perez, &
Martinez,1990). This also agrees with a retrospective study conducted in the Kersa Woreda, area of Ethiopia
which evaluated the Prevalence of malaria from peripheral blood smears which reported that patients aged
31-40 accounted for highest number of positive Plasmodium falciparum smears among 8 age categories
with 104(14.9%) out of 698 (Karunamoorthi & Bekele, 2009) this is however in contrast with another study
in Columbia on the epidemiology and control of malaria which stated that, young adults between the ages
of 18–30 years of were the most affected ( Rodríguez et al., 2011). This variation may be as a result of the
design of this particular study which involved 3 species of plasmodium (Plasmodium vivax, Plasmodium
falciparum, Plasmodium malariae). There was a statistical significance between the screening results and
age (p=0 .028156) indicating that age range is significantly associated Plasmodium falciparum screening
results.
Religion of the participants appear to have no major difference in terms on frequency and statistical
significance. There was no statistical significance between the screening results and religion (p=0. 405053)
indicating that religion is not significantly associated Plasmodium falciparum screening results which
shows that adherents of both religions had equal chances of being infected with the parasite. This is
agreement with a study conducted by Mavis Dako - Gyeke and Humphrey M Kofie on the factors
Influencing prevention and control of malaria among Pregnant Women Resident in Urban Slums in
Southern Ghana which reported that, there was no significant relationship between religious beliefs of
participants and their malaria prevention and control practices (P = .53) (Dako-Gyeke & Kofie, 2015).
However, this is in contrast with the finding of a research conducted in south western Nigeria which
reported that 89.3% of pregnant women refused to take malaria drugs due to their religious inclination
(Adefioye et al., 2007).
Participants educated up to tertiary level appear to be the most involved in self-medication practices with
anti-malaria drugs (54.68%) this agrees with the findings of a study by KP Osemene and Lamikanra in their
study published in the Tropical Journal of Pharmaceutical Research which revealed that age, gender and
students’ level in the university influenced self-medication practices (Osemene& Lamikanra, 2012).This is
in contrast with another study which evaluated self-medication practices in rural Sahaswan at Northern
India which reported that the prevalence of self-medication was high primarily among illiterate males aged
above 15 years with a low income (Ahmad et al., 2014). This variation could also be as a result of the
difference in population (rural and urban) as in this case with this research. The marital status and
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educational qualification of the participants also does not appear to have any significant correlation with
screening for Plasmodium falciparum for individuals purchasing anti-malaria drugs for self-medication
(p=0 .7569) which indicates no significant statistical difference between them. This result is at variance
with a similar study conducted in Ghana on the burden of malaria in mobile populations in the Greater
Accra which showed that marital status, occupation and educational level were significantly associated with
malaria (Diallo et al., 2017) This could be due to the category of the population studied in this case mobile
population. However, another research published in the Tanzania Malaria journal, reported that Education
level was associated with higher score for preventive action against malaria agrees with the findings of this
study (Spjeldnæs, Kitua, & Blomberg, 2014). The level of accuracy of self–diagnosis for malaria was higher
in women 30.58% as compared to men who recorded 21.97%. this could be largely due to experience from
symptoms in the children they nurse and the fact that pregnant women are more susceptible to malaria than
men (Duffy & Fried, 2005). The precision of self-diagnosis was also highest among participants aged > 60
who recorded 41.82% and while the lowest was level of precision or accuracy was recorded among
participants aged 18-30(15.14%).
Conclusion
According to the Nigerian Medical Journal Four species of plasmodium are responsible for malaria
infestation in the country namely Plasmodium falciparum, Plasmodium malariae, Plasmodium ovale and
Plasmodium vivax. Of these species, Plasmodium falciparum is the commonest in Africa and responsible
for up to 98% of malaria cases in Nigeria (Nwali et al.,2015). with a large percentage of the participants
purchasing anti malaria drug for self-medication testing negative to the parasite 336 (71.49%) it is evident
from the finding of this research that a significant amount of resources which could have been used for
other profitable activities is being wasted on unnecessary medication due to wrong diagnosis. The practice
of consuming antimalarial for the treatment self-diagnosed cases of malaria appear not to be effective or
efficient in the diagnosis of the condition .in addition it is also clear that education attainment is linked with
higher frequencies of self-medication largely due to previous prescriptions, adverts, online and online
literatures consulted. Self-medication practices with antimalarial drugs are more prevalent in the age group
31-40 years (36.38 %) while Individuals >60 years of age are the least involved in the practice of self-
medication practice with antimalarial drugs with 1170%. The major conclusion from this research is the
fact that, the Null Hypothesis H0 which stated that most individuals purchasing antimalarial for self-
medication do not have P. falciparum parasite in their blood stream is upheld.
Recommendations
Based on the finding of this study, the following recommendations will be useful in reducing the
financial, economic and emotional burden of malaria on the population
1. There is an urgent need for policy makers in the public health sector to take a second look at the
crisis of self-medication in malaria treatment especially in developing countries
2. Governments at all levels need to provide frameworks, guidelines or laws to stream line the
practice and sales of malaria drugs for self- medication as the haphazard nature of the current
system especially in Nigeria is complicating the crisis.
3. There is an urgent need to improve sensitization of the public on the financial loss, health hazards
and clinical complications associated with self-medication practices.
4. The availability of rapid diagnostic kits should be increased and the possibility of self-testing
with RDT as a pre requisite for purchase of antimalarial medications could be considered in the
near future.
5. Drug stores and their operators including community pharmacies and patent medicine stores
should be encouraged to stock and conduct RDT on customers purchasing antimalarial drugs for
self-medication to promote the practice.
6. There is the need to subsidize the price of RDT kits especially in rural areas to promote the
practice.
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DOI: 10.21522/TIJPH.2013.07.02.Art018
ISSN: 2520-3134
7. Further research on this topic is recommended to uncover other underlying factors associated
with these findings
Summary
This research was conducted to measure the efficiency self-diagnosing practices and the prevalence rate
of Plasmodium falciparum among those purchasing antimalarial drugs to treat malaria due to the
indiscriminate administration of antimalarial drugs including injectable antimalarial agents without
diagnosis of real or perceived conditions. This study answered the following basic research questions.
1. The percentage of individuals purchasing antimalarial drugs for self-medication that are actually
infected with Plasmodium falciparum
2. The percentage of individuals purchasing antimalarial for self-medication that are free from the
parasite.
3. The demographical distribution of those engaged in the practice of self-medication with anti-
malarial drugs.
The study ascertained efficiency and reliability of self-diagnosis and medication in malaria management
and medication practices by screening individuals purchasing antimalarial drugs for self-medication and
provided valuable information that will enable the government of Nigerian and key stakeholders make
informed decision of self-medication practices for malaria infection in Nigeria. The findings of this research
if embraced by critical stakeholders will also assist in enlightenment programs, policy change advocacy
and programs/ clinical projects geared towards stemming the tide of relapse and the rising incidence of drug
resistance in the management of malaria.
If the recommendations of This study are implemented, the burden malaria places on communities’
families and individuals especially in developing countries where treatment of the disease account for a
significant percentage of health budgets will be significantly reduced.
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